Provider Demographics
NPI:1891945259
Name:CARLBERG, NICHELLE RYANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICHELLE
Middle Name:RYANNE
Last Name:CARLBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 ROUTE 60
Mailing Address - Street 2:PO BOX 540
Mailing Address - City:SINCLAIRVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14782-9666
Mailing Address - Country:US
Mailing Address - Phone:716-962-5155
Mailing Address - Fax:716-595-2481
Practice Address - Street 1:5935 ROUTE 60
Practice Address - Street 2:
Practice Address - City:SINCLAIRVILLE
Practice Address - State:NY
Practice Address - Zip Code:14782-9666
Practice Address - Country:US
Practice Address - Phone:716-962-5155
Practice Address - Fax:716-595-2481
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013110-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist